1. Strengthening Organisational Capability Carol Shillabeer, Chief Executive June 2016

2. Organisational Design

3. Operating Model: What is one? An operating model describes where and how the critical work gets done across an organisation. It is a vital link between strategy and the detailed organisational design that it puts in place to deliver the strategy.

4. Operating Model: Keeping it simple Based on LOCR Model – Leading Organisational Change and Renewal (Tushman/O’Reilly) – with some simplifications.

5. Operating Model: Keeping it simple People Board – membership, skills and competencies Executive Leadership – range of roles, skills, knowledge and experience – plus styles (links to culture) Clinical Leadership & Management Professional Leadership & Management Broader workforce capabilities, competencies and capacity

6. Operating Model: Keeping it simple Structure Business Intelligence Finance – strategic planning through to day to day management Information Technology Workforce Management and Development Estates, property, assets & facilities Governance Support Planning & Commissioning Quality Assurance and Improvement Operational Delivery (Change) Programme Management Office

7. Operating Model: Keeping it simple Process Performance Management Framework Change Management Approach Decision Rights & Process Framework (incorporating scheme of delegation) Designated Management Groups Advisory structures (HPF, SRG, Partnership Forum) Standing Orders/Standing Financial Instructions Board Assurance Framework Risk management approach Strategy development approach Business case development

8. Operating Model: Keeping it simple Culture Vision & purpose Values Behaviours Communication & Engagement Recognition & reward Talent development Feedback development & management

9. WAO: Structured Assessment 2015 “.. the Board has set a clear vision, strengthened Executive capacity, and made improvements to governance arrangements. The challenge now is to ensure that there is sufficient resilience, capacity and experience within the Executive team to maintain a sustainable pace of change, strengthen operational management capacity, and to ensure that it has the correct balance between directorate specific and Powys-wide delivery arrangements.”

10. Directorate Model

11. Directorate of Primary, Community Care and Mental Health The role of the Directorate of Primary, Community Care and Mental Health is primarily that of service delivery/operational management: Ensuring operational primary, community care and mental health services are delivered based on population need and organisational strategy; Ensuring that the patient pathway is aligned to deliver services in the most effective way; Coordination of patient care along the patient pathway to ensure the efficient and effective delivery of provider services; and Maximise the extent of safe and effective service provision that can be provided close to home/within Powys.

12. Directorate of Finance and IT The role of the Directorate of Finance and IT is to provide professional leadership and development in relation to finance within the health board ensuring high levels of accounting standards, probity, stewardship and financial governance. The Directorate is also responsible for IT strategy and services for the Health Board. This includes the strategic development of the IT infrastructure including the implementation of major projects, procurement and IT modernisation. The Directorate and Director of Finance will also provide executive leadership for: The operation of services delivered through the NHS Wales Shared Services Partnership Service Level Agreement (SLA); Executive lead for the procurement function delivered through NWSSP; The operation of the section 33 agreements held with Powys County Council; Counter Fraud services; and External (Financial) Audit delivered through WAO.

13. Directorate of Nursing The role of the Directorate of Nursing has responsibility for the professional leadership and regulation of nursing and midwifery; and the development of Healthcare Support Worker workforce through a strong governance framework and in accordance with the Nursing and Midwifery Council and other regulatory requirements. In addition the Directorate and Director of Nursing will : coordinate and monitor the implementation of child protection procedures; provide leadership of safeguarding children and the protection of adults at risk, including deprivation of liberty safeguards and Mental Capacity Act; support the legislative requirements regarding mental health providing oversight of the Mental Health Act; provide strategic leadership for NHS Continuing HealthCare and care home governance; Provide strategic leadership of infection prevention and control, environment of care, public and patient involvement and experience, concerns, complaints and serious incident management, legal claims and implementation of Putting Things Right. The Director of Nursing will be the Statutory Lead Director for Children

14. Directorate of Medicine The Directorate of Medicine is responsible for medical leadership, development and professional regulation of all doctors employed and contracted with the health board. The Medical Director (MD) will act as the principal source of medical advice to the Board on a range of matters relating to medical practice including medicines, service quality and supporting legislation such as the Human Tissue Act for example. The Medical Director will be: the Accountable Officer for controlled drugs the Caldicott Guardian

15. Directorate of Medicine The Directorate and Medical Director will also be responsible for: providing professional leadership for medical education; the oversight of all doctors in training and will support the continuing professional development of all medical staff. This includes the implementation of effective systems to ensure the quality and sign off of job plans, appraisal, training and revalidation for doctors. The Medical Director will be the nominated Responsible Officer for all doctors within the Health Board as required by the General Medical Council; providing professional leadership to clinical networks operating across the health board, including responsibility for integrating the regulatory framework for the provision of healthcare, and encompassing NICE guidance, National Service Frameworks, Royal College advice and revalidation; ensuring all Primary Care contractor services including Shropdoc (i.e. General Medical Services, General Dental Services, Community Pharmacy and General Optometric Services) are fit for purpose and are delivered in line with professional and regulatory frameworks; providing strategic leadership for the organisation in relation to the ongoing research and development (R&D) agenda, strengthening arrangements in place and building on the research capacity and capability of the health board and its teaching status; leading service improvement and 1000 lives; national and local clinical audit; medicines management across the health board and individual patient funding requests; and leading the Resuscitation Committee and the contract that supports the training of resuscitation services.

16. Directorate of Planning and Performance The Directorate of Planning and Performance is responsible for providing strategic leadership and oversight in relation to strategic and operational planning and performance management, the development of all statutory plans (including the long term health and care strategy) together with strategic and operational capital and estates development and the estates strategy, including the management of any strategic capital programme. The Directorate and Director of Planning and Performance will also be responsible for: leading the modernisation of the service planning agenda for the health board in both the medium and long term, and will work closely with local authority partners in the development and delivery of the Powys ‘One Plan’ including arrangements for planning for the Future Generations Act (Wales); providing strategic leadership for the architecture of national plans and their delivery within the health board; strategic leadership and oversight of performance management and improvement, including implementation of effective performance management frameworks ; ensure the delivery of operational information services, clinical information, data quality, cancer information and clinical coding; providing strategic leadership and oversight of commissioning development and operationalisation; and leadership and management of estates and capital, including property related matters and the management of accommodation across the health board.

17. Directorate of Therapies and Health Sciences The Directorate of Therapies and Health Sciences is responsible for providing professional leadership of all Health and Care Professions Council regulated staff, together with associated staff groups and support workers. These professional groups are collectively described as ‘therapy and scientific staff’. The Director of Therapies and Health Sciences will ensure these staff groups contribute fully to service development and redesign, expanding professional capability to support health and social care improvements. The Directorate and the Director of Therapies and Health Sciences will: ensure that the clinical leadership in all professional groups within their portfolio is developed and actively supporting the strategic development and delivery of the health board both in relation to therapy and health sciences development and beyond have a specific role regarding integrated and team working across the health board and Powys County Council, enabling the alignment of systems and process for therapists to best meet the needs of patients. The Director of Therapies and Health Sciences will have a specific role in developing advanced practice within therapies and health sciences working closely with other clinical executives; have a shared responsibility for quality and safety with the Director of Nursing, Medical Director and Director of Public Health; and will specifically lead on health and safety agenda for the health board.

18. Directorate of Transformation The Director of Transformation is a new joint role across PTHB and Powys County Council providing strategic leadership, coordination and oversight of the developing integration agenda, working closely with all directorates and Directors in their respective integration projects and developments. The Directorate and the Director of Transformation will: hold accountability for the delivery of the joint integration programme and will lead and oversee the detailed assessment exercise regarding integration and the subsequent implementation of the findings; lead, develop and deliver programmes of development in relation to whole system integrated care provide strategic leadership and management responsibility for the Programme Management Office; and be responsible for co-ordination and delivery across multiple stakeholders from across the health board (and externally) who are indirectly working as part of the wider project team.

19. Directorate of Governance and Corporate Affairs The Directorate of Governance and Corporate Affairs will be led by the Board Secretary. The Board Secretary will be a principal advisor to the Board and the organisation as a whole on all aspects of governance, working with other members of the Executive team as appropriate. The Board Secretary will, on behalf of the Chair and Chief Executive, lead the design and ongoing development of a governance and assurance framework for the health board and in association with Powys County Council for all integrated service provision, ensuring it meets the standards of good governance set for the NHS in Wales. The Directorate and Board Secretary will take the strategic lead for: Putting Board and Committee arrangements in place, including the development and implementation of an annual Board work programme; Facilitating the annual review of Standing Orders and Standing Financial Instructions; Compiling in consultation with Chief Executive a Scheme of Delegation for functions reserved for the Board, delegated to the Chief Executive and Executive Directors; The leadership and oversight in relation to the development and maintenance of a robust Assurance Framework and organisational Risk Management approach; Internal and External (non-financial) Audit;

20. Directorate of Governance and Corporate Affairs The Directorate and Board Secretary will take the strategic lead for: Setting and implementing standards for the production of corporate polices; Welsh Language/Equality and Diversity; Communication and Engagement, including the oversight of Ministerial and Assembly Member correspondence; Information Governance, including FOI, Subject Access Requests, requests made under the Access to Health Records Act; Engagement of health board solicitors and contract management (including approval and monitoring requests for legal advice); Strategic leadership of records management; Consultations; Host agreements, SLA’s and the implementation of governance arrangements with host organisations; Overarching Section 33 agreements; Undertaking and leading investigations, of a sensitive nature, on behalf of the Chair or Chief Executive; and the delivery of an efficient and effective Executive support and Executive Secretary function.

21. Directorate of Public Health The Directorate of Public Health is responsible for providing strategic leadership to organisational and public health teams efforts to improve and protect the health of the local population. As discharged at local level, this should be delivered across the three domains of professional public health practice, as recognised (for example) by the Faculty of Public Health. These domains are: health improvement (encompassing health inequalities, healthy lifestyles and the “wider determinants” of health); health protection (encompassing communicable disease control, environmental health protection and the public health emergency response); and service improvement (encompassing evidence based healthcare, health service evaluation and audit). Population health surveillance and health intelligence underpin delivery across these three domains. The Directorate and Director of Public Health also takes responsibility for: Emergency planning; Prudent Health and Care; Future Generations Act; Corporate Health Standard; Business Intelligence Change Programme; Heart Plan; and Health of Veterans.

22. Directorate of Workforce and Organisational Development The Director of Workforce and Organisational Development has a major role in mobilising and engaging the talent, leadership and ability of the workforce to deliver safe, effective, efficient and high quality services. Underpinning this will be an active, inclusive and successful organisational development strategy that builds capability, leadership and confidence and enhances the reputation of the health board. This will enable the health board to develop, retain and attract highly competent, ambitious and innovative individuals. The workforce function will be reviewed to ensure it is aligned to meet organisational needs and as such a separate consultation document will be required. The Directorate and the Director of Workforce and Organisational Development will: ensure that the organisation clearly articulates its values and behaviour and ensures that the culture of the health board is developed to meet its aspirations, including a specific focus on the importance of staff engagement; be responsible for ensuring that organisational design is fit for purpose and that the governance around people management and deployment meets statutory and legal frameworks. ensure that the employment services aspects of Shared Services meet the needs of the staff of Powys and that the service level agreement for this area of workforce management meets the standards identified.